The plantar plate is a thick ligamentous structure on the bottom of the foot under a MTP joint. The plantar plate attaches to a metatarsal and a corresponding proximal phalanx. The plantar plate cushions the bottom of the MTP joint and the distal head of the metatarsal while standing, walking, running, and the like. The plantar plate helps bring the toe to the floor while standing.
The plantar plate may become torn or otherwise compromised due to biomechanical abnormalities and/or imbalances in the foot which cause overload of one of the metatarsals and/or MTP joints. Examples of biomechanical abnormalities and/or imbalances include a long first metatarsal, a short second metatarsal, a short third metatarsal, an untreated metatarsus adductus deformity (pigeon toe deformity), arthritis of the great toe (first metatarsal, first proximal phalanx, first distal phalanx), and prior cortisone injection into a plantar plate.
A torn plantar plate causes persistent ball of foot pain despite shoe and/or activity changes, and/or changes in the position of the affected toe and/or adjacent toe(s) such as elevation of the toe (hammertoe).
Current systems for plantar plate repair tend to be bulky and/or complex. Current systems require multiple tunnels to be drilled per bone in order to achieve final fixation, which can weaken the bone(s). Current systems require retrieval of the suture at or very near the plantar plate, which can be very tedious and time consuming in the operating room.
Thus, there is a need for apparatus, systems, and methods for plantar plate repair that are compact, maneuverable, and simple. There is a need for a system that uses a single bone tunnel per bone so that no extra bone preparation steps are necessary, thus saving operative time and maintaining greater bone strength versus systems that use multiple bone tunnels. A system that enables retrieval of the free ends of the suture outside the surgical opening or incision is less tedious and saves operative time.